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Wiki LCD's 22585, 22614

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Amzie

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Chino, CA
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Hello,
I just received a denial from Medicare on codes 22585, 22614 for LCD's. We pull up the list of LCD's from Medicare and the only diagnosis codes listed are for cervical and thoracic? No lumbar codes are listed at all and 22585 is specific to that part of the spine.
Our physician did a 3 level ALIF and a 3 level posterolateral lumbar spinal fusion so I am no idea how to even assign a correct LCD when the codes Medicare gave are strictly cervical

Has this happened to anyone? any advice on how to handle this denial?

The updated LCD from Medicare is Article A59624

Thank you
 
The article is specific only to cervical fusions. CPT 22585 is not listed (22595 is), as a covered code under this LCD. There may be an LCD related to lumbar fusions, but it's not this one.
 
We are seeing a very similar denial scenario when trying to bill the add on code 22585 for a lumbar fusion. The primary code 22558 is paid and the 22585 is denied. The lumbar fusion article does not include 22585; however, the cervical article A59632 does include 22585. Has anyone had any luck appealing with notes?
 
Pam Warren said:
The article is specific only to cervical fusions. CPT 22585 is not listed (22595 is), as a covered code under this LCD. There may be an LCD related to lumbar fusions, but it's not this one.
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We are seeing a very similar denial scenario when trying to bill the add on code 22585 for a lumbar fusion. The primary code 22558 is paid and the 22585 is denied. The lumbar fusion article does not include 22585; however, the cervical article A59632 does include 22585. Has anyone had any luck appealing with notes?
 
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